3.5 -

Health Belief Model
and Adolescents

The School of Health Sciences, Ngee Ann Polytechnic, Singapore

Part 1 The Health Belief Model and Adolescents

While the majority of adolescent morbidity and mortality is preventable, health providers, communities and policy-makers have not given adequate attention to opportunities for health promotion and prevention activities. Changing social norms have led to a number of health problems for adolescents. Adolescent health attitudes and practices not only impact on immediate health status but have long-term consequences, many of which are associated with serious health problems such as cardiac disease, respiratory illness, and HIV. Practices such as smoking tobacco products, use of other addictive substances, or sexual activity without protection from sexually transmitted infections and HIV often does not produce morbidity and mortality in adolescence itself, rather the effects, and the costs, develop over a lifetime. Adolescence, therefore, is a time when creative health strategies and demonstrated interventions can prevent disease and enhance the potential for life-long behaviour that will contribute to the health of the world’s people.

In the previous chapters, we've learnt that there are many reasons why people may be forced by their psychosocial environment to become non-compliant. The Health Belief Model has been widely used to explain health-related behaviours and as a guiding framework for promoting prevention-based behaviors.

The Health Belief Model is best used when promoting individual preventive behaviours, such as contraception use, going for health screening or getting vaccinations. It focuses on the beliefs and perceptions of the individual, so it is appropriate to change behaviours that are not heavily influenced by society and social norms. It tells us the importance of highlighting both the negative consequences of the current behaviour and the positive consequences of alternative, suggested behaviour.

Health Belief Model : Example

Part 2 The Components of the Health Belief Model applied to adolescents

This is a case study on the application of the Health Belief Model in reducing teen pregnancy in the United States of America.

Teen Pregnancy Prevention_ Nine Minutes to Avoid Nine Months.pdf

Modifying Variables - What influence us?

(Ukrich, n.d.)

Individual characteristics, including demographic, psychosocial, and structural variables, can affect perceptions (i.e., perceived seriousness, susceptibility, benefits, and barriers) of health-related behaviors. Demographic variables include age, sex, race, ethnicity, and education, among others. Psychosocial variables include personality, social class, and peer and reference group pressure, among others. Structural variables include knowledge about a given disease and prior contact with the disease, among other factors. The health belief model suggests that modifying variables affect health-related behaviors indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers.

Self-Efficacy - What we feel we can do?

Self-efficacy has been shown to be a causal mechanism in behavioural change that could also prove to be important in prevention efforts. Self-efficacy is seen as an essential element that contributes to an adolescent’s well-being., and also a psychological mediator of health and academic accomplishment of the adolescents.

Key factors that are known to improve self-efficacy in adolescents include the enhancement of skills, responsibility, supportive relationships, and belonging. There is also an increased indication that the promotion strategies have to be age, gender, task, and culture specific to give the best results, and using self-efficacy evaluation measures tailored for the task to be mastered will also show the clearest intervention effect.

Cues to Action - What are the triggers to make us act?

Cues to action are events that act as a trigger mechanism for engaging in health-related behaviour. Cues to action are thought to influence perceived threat as determined by the interaction of susceptibility and severity of risk. Some examples we can apply with adolescents are as follows but not limited to:

Provide youth with incentive items (e.g., pencils, key chains) which contain visual reminders of the message or recommended action.

Putting up aesthetically engaging posters with the action messages in relation to the behaviour of change.

Encourage youth to actively participate in the cause, such as by writing newsletter articles or take on projects to express the action message.

Organize school or agency-wide events showcasing the action message.

Encourage youth to discuss the recommended action with their parents or other responsible adults.

Getting community involved in the awareness and dissemination of the action message. Keeping in mind that it takes a village to raise a child.

Perceived Severity - How serious do we think our illness is?

The probability that a person will change his/her health behaviours to avoid a consequence depends on how serious he or she considers the consequence to be. For example: If you are young and in love, you are unlikely to avoid kissing your sweetheart on the mouth just because he/she has the sniffles, and you might get his/her cold. On the other hand, you probably would stop kissing if it might give you Ebola. Similarly, people are less likely to consider condoms when they think STDs are a minor inconvenience. That is why when talk about safe sex increased during the AIDS epidemic, the perceived severity increased enormously. Here are some examples of ways we can increase the perception of severity in adolescents but not limited to:

Show graphic photos of people suffering from the negative consequences of the behaviour.

Share case studies of people experiencing difficult consequences of the condition.

Lead a visualization having youth imagine they have the condition and are dealing with its consequences.

Share compelling statistics of negative consequences of the negative behaviour.

Invite a guest speaker with the condition to explain what he/she has had to cope with under the circumstances.

Show a video showing people with the condition talking about how their lives have changed.

Ask them in groups to brainstorm at least 20 ways the condition would change their lives for the worse.

Tell youth to imagine having the condition and ask them to each write a letter to their best friend explaining what happened and how it feels to have the condition.

Perceived Susceptibility - How much do we think we are at risk?

The relationship between perceived susceptibility (to risk) and risk behaviour has been applied particularly to adolescents, as descriptions of adolescent risk taking almost invariably make reference to adolescents’ beliefs in their own "invulnerability" to harm.

Below are a list of activities that may help to increase the adolescents' perception of their own susceptibility to the high risk or unhealthy behaviours:

Show them videos which have youth like them with the condition and living with the consequences of their choices.
Generate discussion about whether or not adolescents feel they could get the condition and what are the reasons behind it.
Present recent statistics of youth their age, or from their community, with the condition.
Have them explore web sites that show teens with the condition due to the consequences of the negative behaviour.
Invite guest speakers who look like the youth to share their experiences with the condition.
Ask adolescents to complete confidential personal risk assessments. Have the adolescents analyze the results of their personal risk assessments and then generate a discussion of their perceptions.

Perceived Benefits - How much do we think we will be helped by health advice?

Adolescents are more likely to participate in prevention programs when they can clearly identify the benefits to themselves, their close friends, and their families, but less likely if these benefits are not as clear. We can clearly present the benefits of the recommended action using reliable resources (e.g. information or statistics from the Health Promotion Board [HPB], Ministry of Health [MOH].... etc. ).

Most importantly for adolescents to perceive a benefit from any behaviour is peer group validation. During the adolescent years, friendships are important for several reasons. Adolescents typically spend more time with their peers than they do with their parents, siblings or other social contacts. Therefore, friends influence many aspects of an adolescent’s life. Healthy friendships can help adolescents avoid risky behaviour, delinquency, isolation and many of the negative characteristics that are associated with this period of life.

Perceived Barriers - How much would the actions needed negatively affect me?

Barriers for adolescents in the form of lack of motivation, negative influence from peers, perception of being "uncool" or "different" by their peers, an exaggerated sense of invulnerability as well as emotional conflicts are frequently noted. These barriers can affect their ability to start or stick to any prevention or intervention regime.